Friday, June 28, 2013

CMS Proposed Home Health PPS for 2014 Cuts Payment 1.5%

The Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the Home Health Prospective Payment System for calendar year 2014. The rule affects services provided by home health agencies under Medicare Part A beginning January 1, 2014. The proposed national, standardized 60-day episode payment for 2014 is $2,860.20. CMS projects that as a result Medicare payments to home health agencies in 2014 will be reduced by 1.5%, or $290 million, based on the proposed policies.

The rule proposes the following:

It would remove 2 categories of ICD-9-CM codes from the HH PPS Grouper: diagnosis codes that reflect severely acute patients that are not treated in the home health setting; and diagnosis codes for conditions that would not impact the home health plan of care. As such, these codes will not be included in the update to ICD-10-CM, which is effective October 1, 2014.

Per the mandate of the Affordable Care Act to rebase the HH PPS, it would reduce the national, standardized 60-day episode rate by 3.5% annually 2014 through 2017.

It would increase each of the per-visit payment rates for the low-utilization payment adjustment by 3.5 percent annually 2014 through 2017.

It would add 2 claims-based quality measures, “Rehospitalization During the First 30 Days of a Home Health Stay” and “Emergency Department Use Without Hospital Readmission During the First 30 days of Home Health.”

The proposed rule will be open for comment until August 26, 2013. APTA will analyze the provisions of the proposed rule and submit comments. A detailed summary of the proposed rule will be available on the APTA website in the coming weeks.

In addition to this proposed rule, CMS released the draft of OASIS-C1 to prepare for transition to ICD-10. APTA will submit comments on the draft, which are due August 20, 2013.